The pathophysiology of cervical spinal cord injury: what are the differences between traumatic injury and degenerative disorder

Spinal Cord Series and Cases, 2022 · DOI: https://doi.org/10.1038/s41394-022-00517-7 · Published: April 19, 2022

Simple Explanation

This study investigates the differences in the underlying mechanisms of cervical spinal cord injury (CSCI) caused by trauma versus degenerative conditions. It aims to establish better diagnostic criteria for traumatic injuries without major fractures and improve clinical protocols. The study compared patients with traumatic cervical spinal cord injury (TCSCI) and those with rapid progressive cervical spondylotic myelopathy (rp-CSM), a degenerative condition. The comparison focused on MRI images and neurological assessments to identify key differences. The key finding was that while both conditions share similarities, they are not identical. A crucial factor in distinguishing between them early on is determining if the patient had a pre-existing cervical myelopathy (a degenerative spinal cord condition).

Study Duration

12 Months

Participants

21 TCSCI patients and 16 rp-CSM patients

Evidence Level

Retrospective comparative clinical study

Key Findings

1
T2-weighted MR images showed a high intramedullary signal in the injured segment for all patients at the initial examination.
2
At 12 months post-surgery, 47.62% of TCSCI patients showed an abnormally low intramedullary signal change on T1-weighted MR images, while none of the rp-CSM patients did.
3
Neurological improvement was significantly greater in rp-CSM patients compared to TCSCI patients at 12 months post-surgery.

Research Summary

This retrospective study compared traumatic cervical spinal cord injury (TCSCI) and rapid progressive cervical spondylotic myelopathy (rp-CSM) to refine diagnostic criteria and clinical protocols. The study found similarities and differences in the pathophysiology of TCSCI and degenerative CSCI, with T1-weighted MRI changes being a reliable discriminator at later stages. Early diagnosis hinges on identifying pre-existing cervical myelopathy; detailed clinical history is crucial for differentiating the two conditions.

Practical Implications

Improved Diagnosis

The study suggests that T1-weighted MRIs can be a reliable tool to differentiate between traumatic and degenerative CSCI in the sub-acute or chronic stages.

Differential Treatment Strategies

The findings highlight the need for different treatment approaches for traumatic and degenerative CSCI, considering the presence of pre-existing cervical myelopathy.

Early Prognosis and Rehabilitation

Early and accurate diagnosis can facilitate early preparations for social rehabilitation, leading to better patient outcomes.

Study Limitations

1
The preoperative age and neurological status were significantly different between the patients with traumatic and degenerative CSCI.
2
The pathophysiological difference between traumatic and degenerative CSCI needs to be clarified in greater detail.
3
The study design was retrospective.

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